Disparities in Breast Cancer Screening

Some women are less likely than others to get mammography screening. There are many reasons for disparities in breast cancer screening in the U.S.

Health insurance

A main reason behind differences in mammography screening rates in the U.S. is health insurance. Women who don’t have health insurance are much less likely to get mammograms than women with health insurance. In 2010, only 32 percent of women ages 40 and older with no health insurance had a mammogram within the past two years compared to 71 percent of those with insurance [6].

Although a lack of health insurance is a main reason for breast cancer screening disparities in the U.S., other factors play a role. As noted above, even among women ages 40 and older with insurance, only 71 percent had a mammogram within the past two years [6].

Figure 3.6

In the past, African-American women were less likely than white women to get regular mammograms [76]. These lower screening rates may have increased the chances of African-American women being diagnosed with more advanced breast cancers. This may be one possible reason for the difference in survival rates.

African-American women and white women now have the about same rates of mammography use. In 2010, among women 40 and older, 66 percent of African-American women and 67 percent of white women had a mammogram in the past two years (see Figure 3.7) [6].

Access to follow-up care after an abnormal mammogram may also explain part of the survival gap between African-American and white women. Some, but not all, findings have shown that African-American women may have more delays in follow-up after an abnormal mammogram than white women [77-79]. These delays in follow-up may play a role in the lower survival rates among African-American women [80-81].

Even after accounting for differences income, past screening rates and access to care, African-American women are diagnosed with more advanced breast cancers and have worse survival than white women [74,80-83]. Differences in reproductive factors and breast cancer biology between African-American women and white women also appear to play a role in these disparities [75,83-87].

Hispanic/Latina women

Hispanic/Latina women have lower rates of breast cancer and breast cancer death (mortality) compared to non-Hispanic African American and non-Hispanic white women [88-89].

However, breast cancer is still the most common cancer (and the leading cause of cancer death) among Hispanic/Latina women and breast cancer screening in these women is just as important as it is for African-American and white women [38].

Hispanic/Latina women have about the same rates of breast cancer screening as non-Hispanic African-American and non-Hispanic white women (see Figure 3.7) [6]. However, Hispanic/Latina women tend to be diagnosed with more advanced breast cancers than white women [89]. This may mean that they are less likely to get prompt follow-up after an abnormal mammogram [89].

Asian-American and Pacific Islander women

Asian-American and Pacific Islander women tend to have lower rates of breast cancer and breast cancer mortality (death) than African American and white women [88]. However, breast cancer is the most common cancer among Korean, Chinese, Filipino and Japanese women in the U.S. [90]. And, some ethnic groups, including Native Hawaiian and Samoan women, have higher rates of breast cancer mortality than African-American or white women [91-92]. So, breast cancer screening is important for all Asian-American and Pacific Islander women.

Asian-American and Pacific Islander women have somewhat lower rates of breast cancer screening than African-American and white women [6]. With less screening, women may be diagnosed with more advanced breast cancers, lowering their chances for survival [6].

American Indian and Alaska Native women

Breast cancer is the most common cancer in American Indian and Alaska Native women (Native American women) [1]. Native American women tend to have lower rates of breast cancer and breast cancer mortality than white or African American women [88]. However, these rates vary according to where women live. Native American women who live in Alaska have the highest rates of breast cancer (similar to non-Hispanic white women) and those who live in the Southwest have the lowest rates [93]. Breast cancer screening is important for all Native American women.

Native American women and white women have about the same rates of breast cancer screening. Among women ages 40 and older, 69 percent of Native American women and 67 percent of white women had a mammogram in the past two years (see Figure 3.7) [6].

Lesbians and bisexual women

Some findings show the rates of screening mammography among lesbians, bisexual women and heterosexual women are similar [94]. However, other findings show lesbians and bisexual women may not get regular mammograms due to [95].

Lack of health insurance

Perceived low risk of breast cancer

Past experience of discrimination or insensitivity from health care providers

Low level of trust of providers

One step lesbians and bisexual women can take is to find a provider who is sensitive to their needs. Provider visits offer the chance to get health care, including breast cancer screening, on a regular basis. Networking with other women may be useful in finding such a provider.

Physical disabilities and breast cancer screening

Women with physical disabilities tend to have mammograms less often than women without such limitations [96-97]. One reason is lack of access [98-100]. Many mammography centers (especially mobile ones) simply aren't designed for women who have trouble getting around. Having a good experience increases the chances that women with disabilities will return for routine mammograms [101].

If you have concerns about access, call the mammography centers in your area until you find one that meets your needs. Partnering with your health care provider in your search can make things go more smoothly. The CDC also has a tip sheet for breast cancer screening for women with disabilities. If access to mammography for disabled women is limited in your area, let your local medical centers know. This may help increase access for you and other women.

Getting involved

Disabled women themselves know best how to improve facilities, medical equipment and patient-provider relations. Let your voice be heard by the larger community. If access to health care for the disabled isn't as good as it could be in your area, let your local medical centers, health insurance providers and elected officials know. About 27 million women in the U.S. have a physical disability [102], making a powerful group to lobby for change.

Removing barriers to screening

Many barriers may make it hard for some women to get breast cancer screening. Increasing access, awareness and sensitivity may help remove some of these barriers.

Improving access to mammography and primary care and removing financial and language barriers to screening (especially for poor and uninsured women) are vital to increasing breast cancer screening rates [72,103-104].

Community education (such as health campaigns that address negative beliefs and feelings about mammography) may increase awareness of the value of breast cancer screening and follow-up of abnormal mammograms.

Health care providers working with women from different communities and cultures should be sensitive to their needs. When a provider does not recommend a mammogram, some women do not feel they need one [103-104]. If you are 40 years or older and your provider does not bring up mammography, ask him/her to talk with you about breast health and screening.